Wide access to Catholic health care makes birth control difficult in many places

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Last week, students returning to campus at Ohio’s Oberlin College were shocked: a local news outlet reported that campus student health services will severely restrict who can pick up birth control prescriptions. They are only given to treat health problems – not for the purpose of preventing pregnancy – and emergency contraception is only given to victims of sexual assault.

It has been confirmed that the college has handed over its student health services to the Catholic Health Agency – and like other Catholic health institutions, it follows religious guidelines that prohibit contraception to prevent pregnancy. They also deny gender-affirming care.

“I would describe the student reaction as outrage,” said Remson Welsh, a fourth-year Oberlin student and co-director of the student-run Sexuality Information Center on campus. “A lot of people in my circles were sending. [the news story] Around, what’s going on? ”

Although the college quickly rolled out new plans to offer reproductive health services to students on campus, the incident at Oberlin shows the wide reach of Catholic health care in the US and how the laws these institutions follow restrict contraceptives.

Now that many states — including Ohio — have passed restrictions or outright bans on abortion, this has increased access to contraception.

Religious restrictions affect many health care settings

Issued by the US Council of Catholic Bishops, the ethical and religious guidelines governing Catholic health care systems “prohibit a wide range of reproductive care,” including the contraceptive pill, IUDs, tubal ligations and vasectomies. Dr. Debra StuhlbargA professor of family medicine at the University of Chicago, he researched how these guidelines play out in health care.

Catholic hospitals are the pillars of long-term health care in America. And the guidelines now apply to a wide range of places where people seek reproductive health care — urgent care centers, doctor’s offices and outpatient centers that have been acquired or merged with Catholic health systems.

In addition, Catholic health agencies can apply when they are hired to manage health care services at other institutions, which is what happened at Oberlin.

Four of the 10 largest health care systems in the country are Catholic, a 2020 report. In some regions they dominate the market. In 52 communities, the report found, a Catholic hospital was the only one within a 45-minute drive.

“This is where it shakes out after all this consolidation, where 40% of women of childbearing age live in areas with a high or high Catholic hospital market share,” he says. Marian Jarlensky, A health policy researcher at the University of Pittsburgh, Man He analyzed the data in 2020..

‘It’s not clear at all.’

Patients say they often don’t know how these restrictions affect the care they receive Lois Utley, Senior consultant with the health advocacy group Community Catalyst. They may not know that their hospital or doctor’s office has a Catholic affiliation. For example, one of the nation’s largest health systems, Common Spirit Health, is Catholic, but you wouldn’t know it from the name. And Utley said Catholic health facilities do not make these policies public.

“They’re not clear and transparent about it,” Utley says. “We think it’s fair for a patient to be forewarned about what she can’t and won’t be able to find at a local doctor’s office or urgent care center or hospital.”

as if Campus announcement In a statement Tuesday, Oberlin President Carmen Twilley Amber said Oberlin had learned the restrictions would be implemented by Bon Secours, the giant Catholic health system hired to manage the college’s health services. Bon Secours told the local Chronicle-Telegram. That it only offers birth control prescriptions for medical reasons—an exception allowed in religious guidelines.

Carmen Twilley Ambar, president of Oberlin College, said Oberlin recently learned the contraceptive restrictions are part of a Catholic health system hired to manage the college's health services.  In early August, she joined a meeting with US Vice President Kamala Harris and other university and college presidents on reproductive health care.

/ Samuel Corum/Bloomberg via Getty Images

/

Samuel Korm/Bloomberg via Getty Images

Carmen Twilley Ambar, president of Oberlin College, said Oberlin recently learned the contraceptive restrictions are part of a Catholic health system hired to manage the college’s health services. In early August, she joined a meeting with US Vice President Kamala Harris and other university and college presidents on reproductive health care.

When there are only solutions

In practice, many doctors working at Catholic-owned or affiliated health providers routinely rely on “medical condition” exceptions to obtain religious restrictions, such as contraception, Stuhlbarg’s study found.

For example, hormonal IUDs can be used to control heavy menstrual bleeding, so doctors often say they are prescribing the IUD to treat this condition, even though the real goal is contraception.

Or doctors who aren’t licensed to perform tubal ligations may remove the tubes entirely — they say, just to reduce the patient’s risk of ovarian cancer. Dr. Corinne McLeodSuch solutions were common, she says, when she worked as an OB/GYN at Albany Medical Center, a Catholic hospital in Albany, NY.

“It was basically wink, wink, snap, shake,” McLeod said. [restrictions]One of the problems with relying on such loopholes, she says, is that religious leaders in institutions can lash out if they are attacked.

In other cases, solutions may include creating a separately funded wing within a Catholic hospital or health clinic to provide full reproductive health services.

That’s basically what happened at Oberlin. The college has partnered with a local family planning clinic. He said he would provide these services on campus three days a week, and transport students to the clinic on other days. But the Catholic health provider will continue to offer other health services on campus.

“It’s a start. But it’s not enough,” said Tiffany Yun, a fourth-year Oberlin student who runs the Sexuality Information Center with Welsh. In the past, about 40% of student health center visits were related to sexual health, said Amy Holmes, a certified nurse midwife who worked as a women’s health specialist at Oberlin for many years until the Bon Secours branch took over.

Students at Oberlin College in Oberlin, Ohio, were outraged when they learned who could get birth control at the student health center after Catholic Health System took over student health services.

Students at Oberlin College in Oberlin, Ohio, were outraged when they learned who could get birth control at the student health center after Catholic Health System took over student health services.

“In some cases, women really don’t have a choice.”

Even in the face of adversity, Catholic guidelines can limit women’s contraceptive choices, research suggests. for example, A study was found While it was relatively easy for patients to get an appointment for hormonal birth control at clinics owned by Catholic hospitals, it was rare to find a copper IUD if they needed it, one of the most effective forms of long-term birth control. .

I personally experienced these limitations when I had my second child eight years ago. After I was on the delivery table, when I asked my doctor for a tubal ligation, he told me that he couldn’t do the procedure because we were in a Catholic hospital. According to a recent study, this experience is common: women who give birth in a Catholic hospital are less likely to have a miscarriage To get tubal ligation or removal Like giving birth in another kind of hospital.

Stuhlbarg has conducted surveys that show many people don’t realize their choices are limited because they don’t know their health care provider is governed by these rules. “And from those who had some kind Rejection of reproductive health“Most of them knew they couldn’t find what they wanted when they were there or later,” she says.

In some cases, patients may be able to simply go to another health care provider to get the birth control they need—but not always. “In some cases, women really don’t have a choice,” says Stuhlbarg. “This hospital or this system is the only provider in town.”

A patient’s options can also be limited, she says, depending on their health insurance and whether the providers included in the plan are subject to religious guidelines.

Many experts say these restrictions can often disproportionately affect low-income patients. Dr. Karishma Dara, a family medicine doctor in Seattle, says that when she worked as a resident at Catholic Hospital in Washington, D.C., where she served many low-income patients, patients who came in for IUD appointments were told to leave. to another non-Catholic clinic to have the devices inserted.

“When you have to add another step to access care or contraception, it’s just another point where an unintended pregnancy can happen,” says Dara.

Indeed, Catholic guidelines say that a health care facility may restrict access to contraception long after it ceases to be Catholic. Elizabeth SeperReligious Liberty and Health Law Specialist at the University of Texas at Austin. “There are many examples of a Catholic health system buying a hospital, holding it for only a few years, and then selling the hospital,” she said. But the purchase agreement ensures that the next owner will maintain Catholic religious restrictions.

Reproductive rights advocates want to see laws requiring hospital systems to be more transparent about what health services they do and don’t provide. Legislators in New York have introduced such legislation.

“You know, I’m against Catholic health care, but I think patients should know what kind of care they’re getting.says Jarlenski.

Copyright 2022 NPR. Visit https://www.npr.org to see more.



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